Derry Township resident Pat Day enjoys shopping for walking shoes while on vacation. A five-year pancreatic
cancer survivor, Day recalls days when she could barely walk across the room after surgery for the deadly
disease. Today, she has been declared cured by her doctors.
(Courtesy of Pat Day)

"I am a miracle really. They got it all and I had no lymph node involvement,'' said Pat Day

Pat Day was extremely sick in June 2009, but the Derry Township psychotherapist had no idea because she felt just fine.

"We were sitting on our screened-in porch and my life partner, Becky, looks at me and says, 'Your eyes are yellow. We're going to urgent care,'" recounted Day, who was startled at the alarm in her voice.

Day was about to get a most dreaded diagnosis – pancreatic cancer.

Day is one of the lucky ones – she was a candidate for surgery to remove the tumor and today, she is considered cured.

"In most people, the cancer is so far along when it's found that surgery would not help," said Day, now 70, who is one of just 6 percent of pancreatic cancer patients who are alive five years after diagnosis. "I am a miracle really. They got it all and I had no lymph node involvement."

Hard to treat

That's not to say that her journey from diagnosis to cure was easy; it wasn't. First came a six-hour surgery called "the Whipple" – which involves removing the head of the pancreas, the first part of small intestine, the gallbladder, the end of the common bile duct and sometimes a portion of the stomach, all of which must then be reconnected. Recovery from the surgery, which was done at Penn State Milton S. Hershey Medical Center, was marked by excruciating abdominal pain and extreme weakness and fatigue.

Three months after the surgery, Day had three months of chemotherapy, 20 days of radiation and another two months of chemotherapy. Along the way, she developed compression fractures in her spine due to vitamin D deficiency and suffered a grand mal seizure. For nine months, she battled fatigue that some days left her unable to walk.

"My physical therapy consisted of me sitting on a chair and lifting one leg a few inches off the floor. That would exhaust me," Day said. Her partner Becky Wolfe, an oncology nurse, pushed Day to get up and moving, knowing that recovery depended on it.

There was also the emotional toll the illness took. "I was convinced I would die because no one survives pancreatic cancer," Day said. "Even this past June when the doctor told me I am cured, I said 'No, everyone dies from pancreatic cancer. Why would I be the one who doesn't?'"

Statistics on pancreatic cancer survival are grim. Pancreatic cancer represents only 3 percent of all cancers, according to the American Cancer Society. However, while its incidence is lower than many other cancers – at 46,000 cases diagnosed annually – its death rate is disproportionately high, with nearly 40,000 deaths each year.

In fact, according to a new report in the journal "Cancer Research," pancreatic cancer is predicted to become the second deadliest cancer – behind lung cancer – by 2030.

"We are making a lot of headway with a lot of other cancers as far as screening, early detection, treatment and even cure, but pancreatic cancer remains very difficult to detect and treat," said Dr. Niraj Gusani, surgical oncologist and director of the program for liver, pancreas and foregut tumors at Penn State Hershey Cancer Institute. "So it's not necessarily that pancreatic cancer is becoming that much more deadly, but that we are improving detection and treatment of other cancers."

Pancreas primer

The pancreas is located behind the stomach and has two major jobs – production of insulin and pancreatic enzymes that help digest fatty foods. A genetic mutation causes cells to grow uncontrollably and form a tumor. Most pancreatic cancer begins in the cells that line the ducts of the pancreas, called pancreatic adenocarcinoma. These cells can travel elsewhere, often causing the cancer to spread rapidly.

Because symptoms are vague – weight loss, a feeling of getting full fast, abdominal pain – doctors often don't think first of pancreatic cancer as a possible cause.

In retrospect, Day recalls some shortness of breath and minding cold temperatures, but nothing that would suggest she was harboring a deadly cancer. Her jaundiced eyes were a sign of a blocked bile duct, but often jaundice and back pain don't show up until the disease is much further progressed.

Dr. J. Bret DeLone, a surgeon with Kunkel Surgical Group in Camp Hill, a service of Holy Spirit Health System, knows firsthand how subtle yet ravaging the disease can be. He diagnosed his father-in-law, who was having vague symptoms and had undergone a colonoscopy and some other tests that turned up nothing. DeLone scheduled a CAT scan when his father-in-law was in town for a visit and it showed a mass in the pancreas and metastatic disease in the liver.

Five months later, DeLone's father-in-law died.

"The only risk factor he had was that he had smoked when he was younger," DeLone said.

Other risk factors for pancreatic cancer include family history of pancreatitis, being overweight and having diabetes, he said.

More research needed

A blood test to look for a tumor marker in at-risk people could save lives by identifying people for surgical intervention much earlier when it would be possible, DeLone said.

"I think there is a solid basis for hope that such a test is coming even within the next five years," he said.

In the meantime, better public awareness of pancreatic cancer is needed, doctors said.

The average person doesn't know where the pancreas is located or what it does, Gusani said, and there are few pancreatic cancer survivors to tell their stories and push for more research.

"We need better outreach efforts to get people to specialists sooner so they can take advantage of the better chemotherapy combinations that have become available in the past several years," Gusani said.

"Yes, it's a difficult cancer, but there is hope especially if it is caught at an early stage where surgery is an option,'' he said. "Even at later stages, advances in treatments over the past few years can prolong life, treat symptoms and give a good quality of life."

Positive changes should be in store. In 2013, a law was passed that requires the U.S. National Cancer Institute place a renewed focus on improving diagnosis and treatments for several hard-to-treat cancers, including pancreatic cancer.

Day said she knows just how fortunate she is to be alive to tell her story.

"I thank God every day. Dr. Gusani and Hershey Med saved my life," she said. "There is all this money to research other cancers, but if they would just fund more pancreatic cancer research, people could live."